Individual
MRS. SHAYNE KING DOUGHERTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNP
Contact information
Practice address
32 GREENVIEW LN, HAVERTOWN, PA 19083-4313
(610) 924-9763
Mailing address
3400 CIVIC CENTER BLVD., PHILADELPHIA, PA 19104-4399
(267) 426-5112
(215) 590-3053
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
SP007565
PA
Other
Enumeration date
06/27/2006
Last updated
07/08/2007
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